Stress ulcers are common after aortic surgery. Endoscopic evaluation of prophylactic therapy

Defining who is at risk for the development of postoperative gastric mucosal ulcers and subsequent hemorrhage is an important task when deciding what type of prophylactic treatment is appropriate. We asked 100 consecutive patients requiring aortic surgery to participate in a randomized, double-blind, double-dummy study to compare the effectiveness of antacid titration with fixed doses of a synthetic prostaglandin E1 analog (misoprostol) as prophylaxis against stress gastritis and bleeding. Forty-six of the 100 patients agreed to participate in the study, and 23 were randomized to each arm. The other 54 patients were treated with cimetidine and followed as if they were study participants. Approximately half of the patients had aneurysmal disease, while the other half had occlusive disease. Thirty-one patients developed postoperative complications, and three patients died. Eighty per cent of the 42 patients who volunteered to undergo endoscopic evaluation developed stress ulcers postoperatively. Development of stress ulcers did not correlate with the development of the other complications or with the type of treatment. Only one of the 100 patients (in the cimetidine group) required operative therapy for hemorrhage from stress ulcers, and this occurred after a protocol violation. The endoscopic exams demonstrated that misoprostol and antacid therapy were equally effective in preventing stress ulcers. Patients who refused to participate in the study had significantly more complications than those who did participate by stepwise logistic regression analysis.(ABSTRACT TRUNCATED AT 250 WORDS)